The Good

The longer a rotten system lasts, the more any change to it is perceived to be a giant leap forward. In this light, the House health bill contains some positive changes. Insurers will now be prevented from refusing enrollment based on a pre-existing condition or dropping subscribers who become ill. Such policies have allowed private insurers to maintain profit margins and, consequently, are contributing factors to the swelling ranks of the uninsured. Their elimination is certainly a positive reform.

Another provision in the bill removes the anti-trust exemption for private health insurers. Since 1945, insurers have been exempt from Federal anti-trust law but subject to whatever state-by-state provisions existed. Insurers argued that this allowed them to share essential information about pools of subscribers in order to determine risk. In practice, much more than information was shared. The American Medical Association reports that large insurers now control 94% of health care business in most regional markets. A few large-scale private insurers lord over each segment of the country. House Democrats view anti-trust law enforcement as a means to combat this concentration, but it presents a more ominous prospect when viewed inside of the rest of the reform proposal.

Transforming the mass number of uninsured, at last count around 48 million, into potential customers will favor those companies capable of operating economies of scale. In other words, the larger the corporation, the easier it will be to price your way into the new market. For a time, prices may drop, but only at the cost of further monopolization, this time on the national instead of regional scale. Anti-trust law is a notoriously weak weapon to break up monopolies, since enforcement is contingent on the political appetite of whatever administration directs politics in Washington. Removing the exemption is positive, yet creating the conditions to expand the problem of monopolization seems to neutralize the benefits.

The Bad

Many emotional pleas and an equally large number of words have been delivered for and against the public option. Right-wingers point to it as the crux of the secret socialist plan, while honest liberals made it a litmus test for the utility of the bill. What emerged from the debate is a watered-down version of a public plan sabotaged by concessions made to a vocal right-wing and paid for by campaign contributions to Democrats from the private insurance lobby.

Key to the watering-down was de-linking reimbursement rates from the Medicare schedule. Medicare operates as a price-fixed program where rates are negotiated into annual budgets through the legislature. These are, generally, significantly below rates in the private sector. The House bill version of the public plan will operate with rates determined by the marketplace. This means that the private sector will play a primary role in determining the cost structure in which the public plan will operate. This will end the deflationary effect a Medicare-compensation structure would have and may also mean, as the Congressional Budget Office has argued, that a public plan will be forced to offer more expensive plans than private insurers.

The weak public plan will have negative ripple effects inside the overall reform. The uninsured who can prove financial need, can now apply for “insurance credits” to purchase coverage. However, since the public plan may prove to be more expensive than private plans, it is likely that a significant amount of public subsidies will be funneled into the coffers of private health insurers. This fits with a larger pattern being developed by the Obama administration of funneling good public money into bad private sector businesses that have failed to meet the needs of the American people. The double problems of price inflation inside the plan and the issuance of insurance credits to private companies threaten to drive the already inflated price tag for the reform well past the estimated $1.2 trillion.

The Ugly

In another act of right-wing slight-of-hand, House Democrats shifted the mandate burden from the business community onto individuals. Republican pressure forced the ceiling on businesses mandated to provide insurance to their employees up to $500,000 in payroll. This will allow a significant swath of the businesses to be relieved of the burden of purchasing insurance.

Conversely, individuals will be forced by the government to carry some sort of health insurance. The penalty for not doing so will be a fine of 2.5% of your income. Continued non-payment and remaining uninsured will result in further fines and a possible jail term. This is a bonanza for private insurers, as millions will be forced into a new market for low-cost health insurance. Such plans are sure to skimp on coverage and run high on costs.

The site of the herding will be the new health insurance exchanges. This idea, championed by the conservative Heritage Foundation, will insure that market-based ideology frames the new health care system. Rates will be determined here, insurance offerings will be made and terms of care will be formulated here. All this with the continued logic of the marketplace where profits are a central concern and people’s health an afterthought.

Still Single-Payer

None of the changes outlined above amount to socialism. Nor do they even signal the opening of a road which could lead to a socialist health care plan. The hope for genuine reform rests in the same place as it did before the bill was passed – in the certainty that the private sector will make such a mess of health care that the American people will be outraged enough to move towards socializing health care. A single-payer plan would cut across the good, the bad and ugly of this round of health care reform. Our health would cease to be a commodity and be guaranteed as a human right. Plenty of organizing is needed to win single-payer and, in the immediate term, we have plenty of myths to dispel about the wonders of small reforms.

One of the important offerings in Money Driven Medicine is a clear timeline of the development of the private health care system in the United States (US). The first key moment comes after World War II as many other nations shift to public insurance and publicly controlled delivery of care. In the US, doctors played a key role in preventing the creation of such a public system by asserting their right to determine care. But this physician-centered care was displaced in the 1970s with the rise of Health Management Organizations. “M.D.’s,” Mahar states, “were traded in for MBA’s.” As this business-centered system failed in the 1990’s, private insurers tried to reign in costs by denying costly, but often medically necessary, medical procedures. Backlash ensued and since the late 90s, insurers have liberally approved procedures while jacking up premiums to defend their profit margins. Costs have skyrocketed.

The result is a bloated health care system which rewards specialists who perform multiple procedures instead those who provide good preventive care. A critical assessment is, therefore, offered about the myth that America has the best health care in the world. When it comes to what Donald Berwick of the Institute for Healthcare Improvement, calls “rescue-care” the system performs quite well, but what most people need is open access to simple preventative care. Here Berwick argues, “We are nowhere near the best and it is reflected in outcomes.” The health care system in US pays for doing things not healing patients.

In fact, as studies conducted by the Dartmouth Institute prove, doing more has little impact on positive outcomes. High-treatment states such as New Jersey, which spends 20% more than the average for Medicaid, have equal or worse outcomes than low-treatment states such as Iowa. Physician interviewees in the movie spoke openly about a health system that has been commodified, industrially produced and, finally, is not designed to improve people’s health.

This leads to the second key argument in Money Driven Medicine. The problem with health care is not just lack of insurance; it is an overall lack of access to the kind of care people need. The fee-structure described above has consequences that have filtered down to the training of doctors resulting in a scarcity of primary care physicians. Medical student Krystal Irizarry called primary care, “A burden compensation wise.” Consequently, the film presents multiple patients who have no “medical-home” – no single primary care physician – and are reduced to emergency room visits when minor conditions turn into chronic illnesses.

It is no wonder then, that Mahar found plenty of willing subjects for her study. Five out of six doctors she solicited responded. Most described a health care system slipping out of their control. This idea is brought home powerfully when Dr. James Weinstein describes the story of his daughter Brianna who was afflicted with childhood leukemia. After multiple protocols of chemotherapy, Weinstein objected to continued treatment – viewing the proposed cure as more damaging than the disease. Brianna’s doctors insisted on continuing treatment and threatened Weinstein with a lawsuit if he resisted. The doctors in this case feared a costly lawsuit. The result? Multiple, and ultimately futile, treatments which had no medical justification other than avoiding litigation.

The experience allowed Weinstein to realize that most doctors are not really trained to provide useful information to their patients. What’s needed, the film then argues, is a shift to a more unmediated relationship between doctors and patients. As Weinstein and Berwick and others emphasize, such a relationship need not be unbalanced – with physicians lording over patients. Berwick points to studies which indicate that when provided with the proper medical information, patients tend to make more efficient and frugal choices about their health care. Removing profit-motive from medicine will allow doctors to act like doctors – to place their ethical commitment to patients ahead of bottom-line calculations – and patients to make informed decisions.

Some reservations can be noted about the film. Mahar is an investigative journalist who relied primarily on interviews with medical practitioners to piece together her narrative. Some of the history presented in the film could use a broader contextualization. For instance, the post World War II turn away from a public system occurred, not coincidentally, with an intense witch-hunting of socialists and communists. Aspiring politicians such as Ronald Reagan made great currency as both anti-communist hunters and as spokesmen against socialized medicine. Similarly the 1970’s pivot toward HMOs occurred in a moment of transition for Corporate America away from the post-war production model and toward a neo-liberal strategy of lean wages and slim benefits. These broader developments informed changes in the health care industry.

Ultimately, Money Driven Medicine offers perspectives essential for Americans evaluating proposals for health care reform. As stated in the film, the goal is not to tinker with this or that part of the market system, but to totally re-think the relationship between doctor and patient that has developed under a privately owned system. Undoubtedly, although the film does not state this explicitly, a single-payer national healthcare system offers to best hope for reclaiming the doctor-patient relationship. Unfortunately, the trajectory of the health care debate in Washington seems to be bending more toward the tinkering side. Money-driven medicine in America may be able to survive another attempt at reform.

Schenley Park just outside of the University of Pittsburgh, was the scene of some of the most volatile interactions of the day. At first, student onlookers, seemingly not initially affiliated with the G20 protests, challenged riot police and were violently repulsed. Then, protesters massed in the park and marched on the police line. Tear gas was fired, but the wind was with the protesters and blew the gas back on the police themselves. Massive numbers of police then surrounded the park. The protest dwindled as young people, fatigued by a day of being chased by the police through streets of Pittsburgh, retreated in search of food and much needed rest.

There was property damage today, but it was either defensive or immediately quashed by the protesters themselves. A sound and gas attack by police resulted in the overturning of some dumpsters — a futile symbolic act of self-defense not the justification for repression that the mainstream media has reported. Rocks in BMW and Boston Chicken stores were the frustrated outcome of a crowd whose right to assemble had been forcefully revoked. A small band of protesters went further, by smashing ATMs, but they were quickly persuaded against continuing by march organizers themselves.

The police were everywhere. Pinning down protesters, creating confrontations and randomly stopping and searching. Cops came from Ohio, Florida and Arizona. If their numbers were not enough, they employed anti-protest technology. A Long Range Acoustic Device was employed to beam out high-volume sounds and Twitter-journalist visually identified a microwave heat machine which wasn’t used, but stood at the ready to repel demonstrators. Such tools of repression have no place inside a democratic society.

The protesters were brave, standing up against overwhelming repression, policing themselves and sending the message that capitalism has failed them and billions of others around the world. Equally encouraging were the actions of residents of Pittsburgh. Many extended solidarity to the protesters — opening their homes for relief, providing overnight housing free of charge and disregarding work rules to provide a tired demonstrator with a free glass of water or a seat to rest for a moment. Such acts of solidarity offer a basis to think about a different kind of society, one which moves beyond acoustic attacks and tear gas and towards democracy and freedom.

1. For pics and video visit: http://socialistwebzine.blogspot.com/

The right-wing won this contest without even participating in it. Sure there was one woman with a “Freedom Isn’t Free Shirt,” but there were certainly none of the antics that have come to typify other town-halls. Not even one “Death Panel” sign. How then did the right-wing win? Representative Joseph Crowley (D.), the organizer of the event, insured this by closing off all the spaces for public discussion. Instead of a town-hall, where constituents ask questions or make speeches publicly from the floor, Crowley was only willing to meet people one-on-one in “private” meetings. Barricades on both sides of the Metropolitan Oval Park sectioned off the crowd. A slew of private security guards and NYPD officers enforced the distance. The right-wing tactics had worked. Crowley was too scared to hold an open meeting.

Before I left for the meeting I did a quick search to see who I was dealing with. Crowley has certainly dipped into the health industry pot for campaign funding. The Center for Responsive Politics reports that he received $5,000 contributions from Pfizer, Abbott Technologies (a pharmaceutical company) and the private health insurance company Blue Cross/Blue Shield. No surprise then that Crowley has avoided the single-payer bill in the House (HR 676) and has provided only tepid support for the public option in the House Bill. The literature he distributed makes no mention of a public option. It contains only vague claims about increased regulation and cost reduction.

Now to my story. For the last two years I have been organizing in support of single-payer health care. With more than 45 million people without insurance, millions more underinsured and nearly 20,000 deaths from treatable conditions, the health care system is clearly broken. The responsible party is the private health insurance industry. Single-payer, or the National Health Insurance Act, would make private health insurance companies illegal and establish the Federal Government as the single-payer. As a result, every person in the country would be guaranteed access to health care regardless of their ability to pay.

As an organizer, this has been a complicated campaign. Everyone knows the health care system is a wreck. Yet few understand how this failed system continues to perpetuate itself through advertising, monopolizing market-share and campaign contributions. The language of reform has also served to confuse. The House health care bill and President Barack Obama continually talk about a “public-option” and “universal health care.” Many, including a person ahead of me on line, conflate these terms with single-payer. There is, in fact, no relation between them. The public-option plan is pitched as operating in “competition” with private plans through a health insurance exchange– a schemed dreamed up by the right-wing Heritage Foundation. There is nothing universal about the public-option. It is just another maneuver to defend an inefficient and exploitative private health insurance industry.

While on line, I met a blogger, Eve NYC, from the Daily KOS who offered to video tape my talk with Crowley. She knew that my confronting the senator with his campaign contributions might be the high point of the otherwise vanilla one-on-one meetings. I told Crowley’s assistants that I wanted my session with the Senator taped by Eve. They refused, claiming that the press was not allowed to enter, that the public park was an extension of Rep. Crowley’s office. I argued that this was ridiculous, that it was a public park and that I, and the journalist, had 1st Amendment rights that could not be suspended by his edict. I was immediately descended upon by a team of aides and security guards. I demanded to see Crowley directly and was eventually allowed to enter.

Crowley and I engaged in a borderline juvenile back-and-forth where he claimed his folding chair in the park was his office. I went with the obvious – water fountains, dog-walkers, tweeting birds, benches – it was a public park. And he was a public official who should be accustomed, if not willing, to be video taped. What did he have to hide? After a few heated words of outrage, I was surrounded by security and decided to head off to the mini-stardom which awaited me back on the line.

My conflict with Crowley demonstrates that single-payer activists and even democratic socialists have roles to play in the Town Hall meetings. We should first make sure that they are really democratic; that public officials are not hiding behind barricades, but are forced to face the public. We also have an important educational role to play – patiently explaining the universal benefits offered by single-payer healthcare. Finally, we should expose both Democrats and Republicans for what many of them really are – paid spokespeople for pharmaceutical companies and private health insurers. The website, OpenSecrets.org, offers all the resources you need. Educate, agitate and organize. Timeless injunctions that will serve you well at any town hall meeting, or even, at a town hall charade.

Fresh off a 10-year sentence in US Federal Prison for mail fraud, Carlos Hill employed the time honored strategy of an operator – tell the people what they want to hear. Irrational stock euphoria ran as high in Jamaica in the 1990s as it did in many other parts of the world. Wild stories about individual investors converting thousands into millions became standard mythological fare. Yet if even a few of these stories were based in fact, such opportunities had waned by the early 21st century. Expectations did not. Hill’s Cash Plus Company met these desires with an offer of a 10% monthly return. This was not a pyramid scheme, he argued, because Cash Plus offered a diversified set of assets – in the distribution, gaming, telecommunications, entertainment, security development, industrial and financial services’ sectors. (Jamaica Observer, 3/4/2007.)

By 2008 the bubble had burst on Wall Street and at Cash Plus. An increasingly evasive Hill drew the attention of Organized Crime investigators Jamaica and the ire of mainstream bankers. Then, as the global stock market went into freefall, Cash Plus ceased payments to investors. Hill was arrested, the company declared bankrupt and investors scrambled to recoup losses.

Here the story takes an interesting departure from the Madoff case. Though Madoff appears to have done a fairly skillful job of secreting away his profits, Hill left substantial physical assets – estimated in the billions. This raised the expectations of investors who hoped to reclaiming something approaching 50 cents on the dollar. That is, until Pricewaterhouse Coopers (PwC) appeared on the scene.

PwC is an American company which offers auditing and advisory services globally. The company has had its own scandals including the 2007 Tyco case in which they admitted to carrying out a multi-billion dollar accounting fraud. Despite this, a Jamaican court appointed PwC as the administrator of the Cash Plus assets. Here begins the second, legal round, of investor fleecing.

The PwC administration prevented Carlos Hill from liquidating company assets. It also allowed PwC to put themselves on the clock. Estimates at hourly consultation fees range from US$175 to US$450 or, about more than double what a local Jamaican firm might charge for equal work. To pay the resulting fees, the court has set aside four large properties the value of which amounts to more than $350 million. As a result of this second bilking, PwC informed investors this week that they should ratchet down expectations to something like a recovery of 5 to 16 cents on the dollar. Further fees will be associated with the sale of each Cash Plus asset.

Cash Plus and PwC, two faces of the global financial system. One a sleazy gutter-capitalism peddled by operators like Madoff and Hill. The other perfectly willing to use legal means to strip the carcass dry. With every disaster a new opportunity emerges. Respectable capitalists swoop in quickly – operating in complete legality but equally willing shake down as many people for as much money as possible. PwC has employed the amazing hubris and grotesque efficiency typical of capitalism. No carcass to slim; no pocket book too picked.

It is difficult to tell whether the House-sponsored “America’s Affordable Health Choices Act” is the penance or just straight forgiveness. The Bill purports to be the solution for America’s health care crisis. Representative Christopher Dodd went further, calling it, “The bill we all have been waiting for and fighting for, for 60 years.” Curbs on industry excesses, a public option and high-sounding rhetoric about universal care all dress up the fundamental motivation of the bill – find a way to prolong the life of an already failed private health insurance industry.

Of course, failure is a relative term. Private health insurance companies are quite efficient at completing the task they were designed to carry out, accumulating profits. In 2006, for instance, health care companies accumulated more than $10 billion in profits. Not surprisingly, they are far less able to deliver health care. About 50 million people or 16% of the population, have no health insurance, another 30 million more can be considered under-insured and about 20,000 die each year from treatable illnesses.

Americans have developed two responses to this unjust system – avoiding care and filing for bankruptcy. A recent Kaiser Family Foundation poll indicated six in ten Americans had either delayed or deferred necessary medical care in the last year. The four who do attempt to use the health care system, will likely face the prospects of high fees and, ultimately, indebtedness. The majority, some 52% by last count, of personal bankruptcy claims are, therefore, the result of debts related to health care.

The House bill does little to address the structural failures of private corporations. Instead of a single-payer plan which would address the problem of cost and coverage by eliminating private health insurers’ thereby opening access, the House bill proposes coercive mandates to herd the great mass of the uninsured toward private plans. Key to this is a focus on keeping costs low in the private plans. The problem is that there are only two ways to do this – offer high-fee, high-deductible plans or offer plans with bare-bones coverage. Both maintain high-profitability for the corporations, while fueling the logic of health care avoidance and debt accumulation.

Some of the uninsured may resist this drive into private health insurance plans designed for corporate profitability. The House, under the advice of President Obama, has therefore designed an intricate system of coercive penalties. Americans will either have to prove enough hardship to qualify for the public option or pay a 2.5% penalty on their annual income. Considering the high costs of monthly health care premiums, we can imagine that many may opt to pay the fine in order to avoid the higher costs of a private plan.

To make up the difference, the House Bill proposes the issuance of “affordability credits,” in order to, “reduce cost-sharing to levels that ensure access to care.” Where will these credits, read tax-payer money, be headed? Directly to the private health insurance industry. Here again the new logic of the Obama regime is put to work. Instead of using the state to solve social problems by nationalizing, or socializing industry, the administration chooses to toss tax-payer funds at the private sector. All the while, they employ free-market language – increased competition, market areas and individual responsibility – to cover what is essentially a transfer of public funds to large corporations. No wonder nary a word of protest has been uttered by the normally vociferous private health care industry.

As the House trots out its 1,000 page bill complete with 360 amendments from the Republicans, objections are sure to emerge. Obama and the Congress will face harsh, and not entirely unjustified, criticism from fiscally conservative Democrats and Republicans. Most will base their argument on the Congressional Budget Office estimate that the plan will cost more than $1 trillion over the next ten years. Others will play the small business card, arguing that a disproportionate burden may fall on this sector. A few right-wing libertarians will object to the coercive penalties, but this criticism might be done far more skillfully from the left. Yet, the fact remains that the institutions and the logic that fueled the health care crisis will survive. In fact, those who can claim the largest market share in the health care industry will enhance their position.

What is evident in this debate is the decomposition of the neoliberal capitalist project born in the 1990s. No longer able to peddle the gospel of unfettered markets, corporate America has returned to its origins by making a parasitical living off of state funds. If now, the public sector can no longer be automatically discredited ideologically, it will be bankrupted financially. Obama was more correct then he knew when he commented, in relation to comments made by Republican Vice-Presidential candidate Sarah Palin, that, “You can put lipstick on a pig, but it is still a pig.” Americans would do far better, in regards to the private health insurance industry, with a plate of bacon then a bill for lipstick.

Meanwhile, somewhere in the US House of Representatives there lies a 13 page bill called H.R. 676. This act would create a publicly-funded National Health Insurance Program – a single-payer system. Single-payer would guarantee full medical coverage to every person in the US and would be funded through combining the budgets of existing programs with a payroll tax shared by employers and employees and a tax on wealth. Its existence marks the urgency of the crisis; its elimination from health care reform discussions, the narrow parameters of “the possible” in Obama’s Washington. This confirms the ideas of left-wing advocates of single-payer, that only a mass social movement can make such fundamental changes as the elimination of the private health insurance industry possible. The rallying cry for such a movement might be a slogan from the Black Freedom Struggle of the 1950s and 60s – 99 and a half percent free just won’t do.

Since his election in 2005, Mahmoud Ahmadinejad, under the guidance of the Supreme Leader of Iran, Ali Khamenei, has overseen a regime dedicated to the privatization of state-controlled industries. The intention of the regime, as stated by the newly appointed Governor of the Bank of the Islamic Republic of Iran, Seyyed Shams Al-din Hosseini, is to privatize 80% of state-owned industries by 2010. This mandate was made real just prior to the disputed elections as a state-owned bank, Saderat, announced it would offer 6% of its shares to private investors (Press TV, 6/8/09). Other significant privatizations during Ahmadinejad’s reign include the postal service, two other state-run banks, Tejerat and Mellat, and, in February 2008, a 5% bloc of shares in the publicly owned steel maker, Foulad-e Mobarakeh, was sold out in eight minutes (Iran Daily, 2/14/08). In total, since 2005, 247 enterprises have been processed by the Iran Privatization Organization, the state-ministry specifically charged with overseeing privatizations (Iranian Privatization Organization website).

Khamenei has propelled the process forward. While Ahmadinejad crafted just enough populist rhetoric to provide headlines, the Supreme Leader issued a letter in 2006 ordering the sell-off of banking, mining, industrial, and transport companies — 80% across the board. Ahmadinejad’s ministers have aggressively followed suit. In September 2008, Labor Minister Mohammad Jahromi described the fact that so many of the country’s resources are located in the public sector as an “obstacle” to growth (Iran Daily, 9/29/08). Heidari Kord-Zangeneh, Ahmadinejad’s deputy finance minister and head of the Iran Privatization Organization, drew pro-market policies together with the myth of anti-imperialism. “We are going to activate our private sector and our private banks,” he exclaimed, “in order to fight against these [US] sanctions.” He punctuated this with a pre-election promise, “I promise that if I am here for the next two years, between 80 and 90 percent of the government will be sold” (Iran Daily, 2/12/08).

Ahmadinejad’s supposed anti-Western approach stops short when it comes to allowing foreign investors to penetrate Iran’s economy. His Minister of Economic Affairs and Finance Davoud Danesh-Jafari boasted at a 2008 meeting of the Islamic Development Bank that foreign direct investment in Iran had increased by 138% since 2007. (Iran Daily, 2/17/08) Some 80 projects had been initiated during that period. Key to this capital penetration was the 2004 acceptance of the International Monetary Fund’s (IMF) Article VIII Obligations (IMF Press Release, 9/14/04). Under this provision, Iran agreed to refrain from imposing restrictions on currency transactions and other elements essential to capital flow.

While Ahmadinejad has been the implementer of privatization policies, the reform camp was its architects. Central to this process was the creative violation of Article 44 of the Constitution of the Islamic Republic of Iran. This article mandates that key sectors of the economy remain in public hands. It represented the radical-populist edge of the 1979 Islamic Revolution. Parliamentary legislation in 2004, near the end of the regime of reformer Mohammad Khatami, created the first breech in Article 44. The legislation called for a “change in the role of government from direct ownership and management of enterprises to policymaking, guidance and overseeing” (Iranian Privatization Organization website). The one consistent voice pushing this process forward is Khamenei, whose tenure as Supreme Leader encompasses both reformer and populist presidential regimes.

The IMF has hailed this process describing Iran in a 2007 position paper as, “Managing the Transition to a Market Economy.” The Fund has had a constant presence in the country since 1945, surviving even the turbulent 1979 Islamic Revolution. IMF officials have employed the usual equation of debt and technical assistance to enforce their pro-market agenda. The next phase, according to IMF planners, of market transition is to “curb the growth of internal demand” through the reduction of state subsidies. Ahmadinejad’s Central Bank appointee, Al-din Hosseini, indicated a shared sentiment, “The government plans to implement a strategy that involves significant reforms, the most important of which is the reform aimed at better subsidy system” (IMF Meeting, 10/13/08).

Pro-market privatizations have been combined with harsh restrictions on worker’s ability to organize in order to advance Ahmadinejad’s neo-liberal restructuring of Iran. Although Iran is technically a member of the International Labor Organization, and thereby mandated to allow free trade unions, workers are restricted from forming independent unions. Under the constitution, they are only allowed to join ideologically-centered Islamic Worker’s Councils, which hold no right to deal with worksite issues or collectively bargain. Despite these legal restrictions, privatization and soaring inflation have resulted in a series of escalating confrontations between workers and security forces.

In March 2007, thousands of schoolteachers spilled out into the streets in front of Parliament demanding that their collective grievances be heard and their salaries increased. They were attacked by security forces and their leaders received prison sentences of up to five years. Such repression did not deter Mahmoud Salehi, a baker, from making his annual demand to celebrate May Day. Salehi was found guilty of “acting against national security” and imprisoned. This year, in a small preview of the post-election street protests, Ahmadinejad’s security apparatus was used to repress 2,000 workers who attempted to organize a May Day celebration.

But the real foil to Ahmadinejad’s pro-market policies is a middle-aged bus driver from Tehran. Mansour Osanloo, acting as the president of the 17,000 worker-strong Syndicate of Workers of Tehran and Suburbs Bus Company, led a 2005 strike in which drivers refused to accept fares in protest of working conditions and rising fares. The strike was immediately criminalized with Osanloo and fellow leaders placed under arrest. Undeterred, Osanloo led another strike attempt in 2006. He was again arrested and today sits in a cell in Iran’s notorious Evin prison — a living testament to both the courage of Iranian workers and the repressive nature of the regime.

Soon to be joining Osanloo in Evin are thousands of protesters who have also been criminalized by Ahmadinejad and Khamenei’s regime because of their protests over the stolen election. While it is difficult to describe a candidate with as many establishment credentials as Mousavi as a reformer, it is easy to see how the demonstrations on the street have rapidly progressed beyond his campaign. Slogans have moved from “Mousavi get our votes back” to “Death to the Dictator.” With this shift come possibilities for more radical measures. Automotive workers at Khodro Automobile Company have pledged resistance, university students are conducting sit-ins, and the Bus Drivers Union has issued a call for international solidarity.

Meanwhile, somewhere deep inside Evin prison, clandestine communications may be being initiated between a jailed bus driver and a newly minted student radical or an ailing baker and young rock-throwing worker. These actors need little help in understanding that Ahmadinejad’s regime, despite all his populist rhetoric, has worked hand-in-hand with IMF privatizers. After failing to deliver on his populist rhetoric, Ahmadinejad has stolen the election. Now, his only recourse is state repression. On the streets, something far more brilliant is underway — an open-ended emancipation project demanding nothing less than political freedom.

Of course, Obama is no George W. Bush. He knows well how to pick off the low-hanging political fruit in order to forestall decisions which threaten to bring his administration into conflict with organized interest blocs. Moving swiftly to close the moral eyesore that is the detention center in Guantanamo Bay signals a return to the normal operation of US Empire. Equally useful is his enactment of measures furthering governmental transparency. This may sooth lingering doubts about Obama’s associations with now-impeached Illinois Governor Rod “Let’s Make a Deal” Blagojevich. It would be difficult to discover many speakers – apart from those on the fringe of the radical right — willing to defend either Guantanamo or Presidential secrecy.

More significant resistance will be provided to any serious attempt to end the US occupation of Iraq. Evidence of this was provided during the nightly News Hour program aired on Wednesday January 21st. The segment was entitled “Next Steps for Iraq,” and featured the pro-Bush retired General Jack Keane and the Obama-ally retired General Wesley Clark. Both Keane and Clark delivered a clear message — no troop removal anytime soon.

Keane, the military author of Bush’s “surge strategy,” claimed that Obama’s campaign pledge to remove troops by 2010 “rather dramatically increases the risks” in Iraq. He recommended a “minimal force reduction” in order to “protect the political situation.” Though a 2010 departure was “a risk that is unacceptable,” Keane assured viewers that “Everyone knows that we are going to take our troops out of Iraq.”

The Democratic Party’s dog in the fight, Wesley Clark had little bite as be agreed with Keane’s assessment “it [Obama's troop removal pledge] is risky.” “When President Obama made that pledge almost a year ago,” Clark claimed, “the context of what combat troops was, was taken from the legislation that was going back and forth through the House and the Senate.” He then provided a key qualification, “Distinguishing combat troops from trainers, from counter-insurgency troops or counter-terrorist troops that would go against Al-Quada in Iraq and distinguishing them from the logistics troops.” “So,” Clark concluded, “to say that all combat troops will be out in 2010 in sixteen months doesn’t necessarily mean that all troops will be out by 2010.”

If this double-speak was not enough, Clark then provided another clear signal that the Obama campaign pledge may fall far short of anything resembling a remotely anti-war position. Clark praised Keane as the architect of the surge policy and “the success that has been achieved through it.”

Not surprisingly, Keane agreed with the non-combative Clark. He “understands the distinction” between combat and other types of troops. Even if some combat troops were removed, Iraq would still require “a significant number of combat troops” to protect the other types of American troops. Clark then introduced a new term to the discussion (any possibility of a debate had long since passed) — “re-deployed.” He ended his contributions by highlighting the “the need for troops in Afghanistan.”

The Clark-Keane discussion should be quite useful for anti-war activists. It clearly signals that the “surge-consensus” forged by the Bush administration is still fully operative among the military establishment in Washington. Obama’s desire for continuity in military strategy, signaled clearly through his re-appointment of Robert Gates as Secretary of Defense, should be understood as his acceptance of the positions articulated by Keane and Clark. This presents a sharp challenge to the anti-war movement.

Two tasks are clear. The first is to articulate a clear demand for the complete removal of all US military forces from Iraq. The anti-war movement cannot allow distinctions to be made between combat or counter-insurgency troops, military advisers or technicians. All troops need to be removed immediately. Second, and perhaps even more challenging, is the demand to remove all troops from Afghanistan and to resist any attempt at re-deployment from Iraq. Perhaps a bit of “cold-eye realism,” beginning with the fact that more than one million Iraqis have died as a result of the US occupation, should be employed by the anti-war movement as we begin the process of challenging an Obama presidency whose military policy has started off sounding a lot like a re-hashed version of George W. Bush.

Occupation was the tool to advance this demand. The occupation was initiated by a loose grouping of graduate students allied with the primarily undergraduate Radical Student Union (RSU). The RSU is a split-off from the Students for a Democratic Society and has organized a determined year-long campaign against L3 Communications centered on the company’s role in the operation of the notorious Abu Ghraib prison in Iraq. Energy from this campaign intersected with local New School demands for greater access to email, student space and representation on the decision-making bodies. The outcome – occupation!

The call for support demonstrations outside of the occupation was well received. Hundreds of people gathered throughout the night to feed off the positive energy created by the occupiers. Just when the crowd seemed to dissipate new arrivals brought fresh enthusiasm. Clear influxs could be seen seemingly every two hours from 10:30 pm on. Passers-by also popped in to receive spontaneous 5-minute educationals from participants.

Most in the crowd referenced events in Greece, Rome and the Chicago factory occupation. There was a sense that if we were not indeed witness the start of a new movement at least the occupiers had created a space in which one could think a bit more boldly about possibilities. The interesting problematic many wrestled with was how an action at this primarily elite university could be exported to working-class students at CUNY feeling the pressure of impending tuition increases. No sure answers were gained but the vague sense of impending victory through direct action was enough to spur on conversations.

Sometime after 3am supporters and occupiers were reunited on the side of 13th street as the occupation ended. The occupiers voluntarily dis-engaged after Kerrey agreed to a series of proposals. The occupation did not remove him. However, the occupation did force the school into concessions around student representation, the removal of restrictions on school email and created some larger space for student association.

The end of the occupation was not without its dissenters. Students from a low-income student caucus of New School students attempted to advance demands for financial assistance but were mostly rebuffed. They voted against ending the occupation and wished to widen future struggles. Their complaints highlighted a common refrain among occupiers who, after dis-engaging, wished to do more “base-building” among the student population.

Overall, the occupation was a victory. It was a victory for a particular method of direct action politics which is sorely needed in the US. There will be no Greece in the US anytime soon but the energy and romantic leaps made by university students still hold the possibility for reviving the near-moribund political imagination of the left. Occupy-Refuse-Resist!

The Cruelty of the Cuts
Of course, not all targets are equal – some are simply crueler than others. The budget cuts will adversely affect already vulnerable communities such as the aged and the disabled. Elderly New Yorkers have already felt the sting of cutbacks. The Department of Aging recently eliminated the five days a week delivery of hot food replacing it with twice weekly drop-offs of frozen meals. This cutback decreases the amount of human contact between aid workers and homebound elderly. For many older New Yorkers the food delivery person may be the only human being they interact with all day. Paterson’s budget proposal promises further cuts to essential services for the elderly such as the Medicare program.

Disabled New Yorkers also face dire consequences inside of the doomsday budget. The Metropolitan Transit Authority, working under Paterson’s mandate to slash the budget, is proposing to double the cost of Access-A-Ride trips from $2 to $4. Such an increase threatens to place serious limitations on the finances and mobility of the disabled while providing little in the way of savings.

The above-mentioned proposals are a small portion of the proposed cuts and are meant to highlight the gross inhumanity of Paterson’s proposals. Even larger cuts to our already overburdened transit and education systems are sure to make life worse for all poor and working class New Yorkers.

Shared Suffering
Such cutbacks will be a hard sell for Paterson and Albany politicians. As a result they have once again dusted off the “shared suffering” argument. “This is nobody’s fault,” Paterson related “and everybody’s responsibility.” A quick glance at how New York finances operated prior to the financial crisis reveals that while politicians firmly wish to share suffering they are quite miserly with prosperity.

The situation of New York City Transit Workers offers the clearest example of how little payoff workers received during the previous period of “prosperity.” While tax revenues from Wall Street boomed in the late 90s and early 21st century, transit workers were offered meager wage increases coupled with workforce reductions. The pressure came to a head during the 2005, 3-day transit strike. Following this, and well before any financial crisis, the TWU leadership signed a contract in which workers were forced to make a 1.5% payment for their healthcare plan. So much for the good old days.

Transit workers now face the possibility of mass layoffs as a result of the MTA budget proposal. Multiple token booths, routes and nighttime stations are scheduled to be closed. This adds both workers and riders to the list of those targeted for suffering in the name of budget cutting.

False Choices
As Naomi Klein’s widely read book The Shock Doctrine suggests, economic disasters offer elites the chance to implement changes not possible during normal periods. In the case of New York, CEOs at the non-profit healthcare insurers GHI & HIP have used the cover of financial crisis to attempt to privatize the companies. Such a change would place 4 million New Yorkers at risk of higher premiums, denials of care and skyrocketing CEO salaries. Recipients of Medicare and Medicaid also face the prospect of being dropped entirely should the companies become for-profit.

The financial carrot in this deal comes from the fact that the privatization could yield a one-time payment of up to $4 billion for NY State. While quite lucrative in a moment of shortfall, such an infusion of funds would come at the cost of exposing millions of New Yorkers to an already failed for-profit healthcare system. A financial strategy could quickly become a public health crisis. Such are the false choices offered as part of budget cutting.

Ways Out
David Paterson has already made an important choice. He has decided to go down the path of cutting spending instead of increasing revenue. In doing so, he disregarded the advice given to him by Joseph Stiglitz, the 2001 recipient of the Nobel Memorial Prize in Economics. Stiglitz advised Paterson that “it is economically preferable to raise taxes on those with high incomes that to cut state expenditures.” Increasing, rather than decreasing, state and local spending helps to move economies out of recessions by injecting cash directly into local economies.

Stiglitz advocated for a “millionaire’s tax” which would put idle wealth back into circulation. Couple this with a tax on financial transactions conducted in NY State and the budget deficit would be closed. Further savings might also be gained by the implementation of a national health insurance system, which would remove a major cost for state government and provide universal quality care. Each of those proposals also serves to stimulate a now severely recessed economy.

Such suggestions offer concrete ways to move beyond the logic of budget cutting. Paterson, however, disagrees, “I think taxes are addictive,” he told the NY Sun, “What happens is when you start taxing, people start thinking of ways of spending money that you taxed.” This is, of course, precisely the point. The New York economy is desperate for greater spending and taxing the rich will put idle wealth into circulation.

Fight-Back
Stopping the cuts and re-directing New York politics down a new human-centered progressive path in which the rich are made to pay for the financial mess they have created will come about through grassroots mobilizations. We must encourage democratically organized political expressions that reflect the growing anger and disillusionment of poor and working class communities. All available forms of non-violent protest — from sit-ins to occupations, from education to mass direct action — must be employed in this struggle. All New Yorkers are invited to participate in such a movement which holds the potential to not only stop the budget cuts but to demonstrate that another, better, world is possible.

The ASG test is marketed toward parents interested in determining their children’s “natural predisposition” towards particular sports. For $149 and a swab of the back of the child’s throat, ASG will search for the presence of the gene named ACTN3. Scientific studies, the company claims, prove that the presence of R577x, a variant on the ACTN3 gene, allows the body to interpret signals from the gene in a manner which predisposes a child for either endurance or endurance and power sports.

According to a recent NY Times article,¹ the primary study supporting the testing was conducted on 429 elite white athletes including 50 Olympians. 50% of the 107 sprint athletes had two copies of the R577x variant. Some 25% of elite endurance athletes also had two copies. Conducting such tests after the fact creates interesting scientific hypotheses. Marketing the conclusions to parents with young children has the potential to place serious limitations on the activities engaged in by young people.

Parents willing to participate have read the test as an opportunity to gain a strategic advantage for their children. Since the test has been marketed to parents with toddler age children, test results could translate into the very early tracking of youth-athletes and the further creation of hyper-competitive youth athletics. This fits the general trend identified by child psychologist Bill Crain who argued that adult pressures to perform in narrowly prescribed ways are increasingly being imposed on children. In his book Reclaiming Childhood, Crain cited a report which documented the concerns six-year old’s held about college admissions.²

One key part of the high-pressure regime comes when adults assume too much control over childhood. For instance, early responses to the ASG test have placed the focus squarely on the positive benefits for parents instead of the consequences for children. Donna Campiglia a 36 year old mother from Boulder, Colorado who supports the test told the NY Times, “I think it would prevent a lot of parental frustration.” Boyd Eply, a former conditioning coach for the University of Nebraska said the test could help, “set realistic goals for you and your children.” Parents, who will ultimately become ASG consumers, are placed at the center of considerations even as test results threaten to narrow children’s life possibilities based on their genetic makeup.

Luckily for children everywhere, the ASG test was not administered to Dustin Pedroia. If genetics determined possibilities, the diminutive Pedroia would certainly have been relegated to the sidelines. In fact, seemingly any other objective measurement including size, speed or style of swing, Pedroia has a long looping swing, could have been used to disqualify him. Thankfully, sports retain many features which transcend genetics such as determination, luck and collaboration. Pedroia made the most of these while producing an AL MVP season with 17 home runs 83 runs batted in 118 runs scored and a .326 average.

For Dustin Pedroia, and every other professional athlete, sports are now a business. He received his monetary reward in the form a six-year $40 million contract. But youth sports should remain something other than a business. Youth sports should not be shaped by “realistic goals” but should create safe spaces for open exploration and development. Young people should be encouraged to enjoy the pleasures of camaraderie without regard for the possibilities of future professional success. Reading future potentials or narrowing activities based on genetic makeup will only allow the marketplace to take a firmer hold on the future. This is the surest road to a spoiled childhood and societal divisions based on genetic makeup.

Our society should be encouraging the next Dustin Pedroia to develop by removing the already existing restrictions on youth sports. Every child should be able to explore a wide variety of activities regardless of wealth or genetics. “Few tragedies,” the late Evolutionary Biologist Stephen Jay Gould wrote, “can be more extensive that the stunting of life, few injustices deeper than the denial of an opportunity to strive or even hope, by a limit imposed from without, but falsely identified as lying within.”³ ASG is a company dedicated to producing limitations on youth in the name of profit. Let youth be youth and explore every avenue of possibilities. Our society will be the better for doing so.

1. Juliet Macur, “Born to Run? Little Ones Get Test for Sports Gene,” NY Times, Nov. 30, 2008
2. William Crain, Reclaiming Childhood: Letting Children be Children in Our Achievement-Oriented Society, Times Books, 2003.
3. Stephan Jay Gould, The Mismeasure of Man, Norton, 1981.

Paterson’s plan involves the most sinister reversal of participatory budgeting ever devised. The new state-sponsored website Reduce NY Spending claims that “New York faces a $47.0 billion deficit over the next four years – the largest in state history” and asks visitors to, “determine how to move forward and implement responsible spending reductions.” You are then asked to use the Budget Balancing Calculator to determine the features of the state budget. There is, of course, one catch. Participants are only able to adjust the spending and not the revenue side of the budget. Thus, you can only cut spending from a variety of sectors of the state budget.

The choices are brutal. Does one cut from School Aid or Medicaid? Mental Health Services or Higher Education? Transportation or Public Health? The blighty wounds mount as one looks through the list. The cuts will have to be large since the governor claims that the budget deficit for this year alone amounts to some $12 billion dollars. The real question is not what will be cut, but, Why should New Yorkers be faced with such choices? Why should we pit teachers against transit workers? Nurses against Counselors? Our safety on NYC buses versus our children’s education? The answer is that we do not. These are the false choices of neoliberalism.

Missing from the Reduce NY Spending website is any mention of a meeting that took place in early 2008 between Governor Paterson and Columbia University Economist Joseph Stiglitz. At the meeting Stiglitz recommended a wealth tax as the most efficient means of closing NY State’s rising budget deficit. A tax of 6% on all income above $5 million would cover an estimated $6 billion of the deficit. Stiglitz favors tax increases because he claims that state and local government spending provides a greater positive economic impact than budget cuts. The implementation of a progressive tax structure, a larger capital gains tax and a small tax on financial transactions conducted in the state would more than cover the rest. Of course, this would mean allowing New Yorkers to adjust the “revenue” side of the Budget Balancing Calculator!

None of this will happen spontaneously. Left to his own devices, Paterson will continue to trumpet a message of cutbacks and the privatization of essential services such as the non-profit health insurers GHI & HIP. Though he may ask for public input on the cuts, New Yorkers can see this as a blighty wound scenario. Instead of self-inflicted wounds, we need to build strong movements to defend the services necessary to the everyday lives of millions. By doing so, New Yorkers will refuse to be divided based on job title or budget line. No website, no matter how slickly constructed, can build a consensus around cutting back on things which should be human rights.

Unfortunately for the McCain campaign, a large chunk of the American electorate, despite eight years of presidential idiocy, has managed to retain some amount of rational reasoning. By any reasonable measure Obama is far from a socialist. Let’s look at three.

Healthcare

In his Chicago days, Obama was close to a socialist position on the issue of healthcare. He was an early supporter of House Resolution 676, a bill introduced by Representative John Conyers which would create a single-payer national healthcare system. This bill would effectively eliminate the private health insurance industry. While many socialists support this proposal, we also call for a fully socialized healthcare system where both the healthcare program and facilities are publicly owned.

Obama the presidential candidate has slid far from his earlier position. The wheels for this move were greased by nearly $12 million in campaign contributions from the healthcare industry. He now advocates a pro-business reform for the healthcare industry which offers meager public support while unlocking untapped market sources through a system of child-insurance mandates.

War & Peace

Socialists rightly emphasize the military industrial complex and the social philosophy of militarism as important drains on public funds and the national psyche. The US spends an estimated $1.4 trillion on the military through expenditures on current and past military campaigns. This amounts to 54% of the entire public budget. US military spending is equal to the sum total of the next 15 countries combined.

Obama has offered little on this subject. He has made an blanket claim to end the occupation of Iraq but has simultaneously offered overtures about increased military activity in Afghanistan. This has been coupled with irresponsible comments about aggression towards Pakistan. Conversely, Socialist Party USA presidential candidate Brian Moore has not only pledged to immediately withdraw from Iraq and Afghanistan but also to make a 50% cut in the military budget. Obama has offered no similar proposals.

Economy

Obama’s economic package has vacillated between a continuation of the Clinton regime where fiscal policy was run by the Wall Street bankers and wholly insufficient stimulus proposals. The Clinton-style lower taxes, balanced fiscal budget and cuts in social services is wildly out of touch with an economy desperate for stimulus to prevent a total free-fall. On the other hand, moderate liberal proposals such as simply reversing Bush’s tax cuts for the rich and offering minor tweaks to spending just will not cut it.

If socialists understand anything economically it is how to deal with capitalist-created recessions. The state must become an engine for economic stimulus to revive an increasingly dormant economy. This can be partially achieved by state-guarantees of necessary items such as healthcare, water, education and housing. A far more complex challenge comes from the need to rebuilding productive capacity in the US. This can be done in democratic and green ways through socialist-based worker-cooperatives teamed with strategic nationalizations. Do not expect Obama – as either candidate or president – to embrace such radical, yet increasingly necessary, ideas.

So, we see that in the land of “knowns” Obama is far from a socialist. On a good day he is a mild liberal reformer but on most he is closer to a Clinton corporate-directed centrist. This will not prevent the McCain-Palin crew from conducting their best Senator McCarthy routine. This has been a tried and true part of American politics. However, this year there may be a few road bumps. We are four generations removed from McCarthyism. There is also no Soviet Union to poke fun at. And finally, and most importantly, America needs a socialist peace plan, a socialist healthcare plan and a socialist economic stimulus plan. Such things are available but will not be delivered by Barack Obama.

An even more frightening picture is painted when the numbers are examined more closely. The average payment made by a worker for a family plan has increased from $129 in 1999 to $280 in 2008. The squeeze on budgets also has a regional flavor with workers in the South paying a monthly charge of $313 for a family plan while workers in the Northeast are charged in average $246 (although a monthly charge for a single-plan of $75 for Northeast workers is the highest in the country). Employment sector and union status is another factor in the percentage a worker will be forced to pay with wholesale, retail and finance sector workers being asked to pay nearly 20% of single and nearly 30% of family premiums while federal/state/local government workers, who are generally represented by trade unions, pay only 12% for single and 21% for family.

Costs inside of plans have also increased sharply. Take for instance the charges by HMOs for visits to a physician’s office. In 1999, 83% of plans charged a $10 co-pay or less. In 2008, nearly 70% of plans charge $15 or more. Things are even murkier when prescription drugs are considered. Tiering, or creating levels of cost for pharmaceuticals, was introduce en-masse in 2000. A scale of three tiers was employed initially. The first-tier cost of drugs has increased from $8 on average in 2000 to $10 in 2008. However, a fourth tier was introduced widely in 2004 priced at $59. This cost is now $75 and the third tier has increased from $29 in 2000 to $46 in 2008.

The end result of this squeeze is, not surprisingly, enormous profits for health insurance companies and serious pressure on the household budgets of workers. Health insurance giants Humana (18%), United Health (5%) and Aetna (8%) have all reported profit increases for the period from 2006 to 2008. CEOs for companies were well-rewarded with compensation packages which amounted to $10 million, $9 million and $23 million. Simultaneously, a 2005 study indicated that 50% of personal bankruptcy claims, more than 2 million, were based on debts incurred as a result of medical procedures. A correlation has also been made between healthcare and problems with housing including inability to pay rent or mortgage payments.

In sum, we see that healthcare is a serious class issue. The for-profit health system represents a serious financial drain on working-class households and is interlinked with, the now much publicized, problems in the home-loan mortgage markets. The creation of a single-payer national healthcare insurance is therefore the very definition of the term “bailout.” The only difference, and this is a key difference in a society in which corporations monopolize political power, is that instead of the government purchasing worthless mortgage-backed securities, the entire society would be relieved of the financial stress of healthcare bills and psychological anxiety of a future where healthcare is not a guarantee.